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Intensity of anticoagulation and survival in patients hospitalized with COVID-19 pneumonia

BACKGROUND: SARS-CoV-2 infection has noted derangements in coagulation markers along with significant thrombotic complications. Post-mortem examinations show severe endothelial injury and widespread thrombotic microangiopathy in the pulmonary vasculature. Early reports describing the use of prophyla...

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Autores principales: Hsu, Andrew, Liu, Yuchen, Zayac, Adam S., Olszewski, Adam J., Reagan, John L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Ltd. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511207/
https://www.ncbi.nlm.nih.gov/pubmed/32980620
http://dx.doi.org/10.1016/j.thromres.2020.09.030
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author Hsu, Andrew
Liu, Yuchen
Zayac, Adam S.
Olszewski, Adam J.
Reagan, John L.
author_facet Hsu, Andrew
Liu, Yuchen
Zayac, Adam S.
Olszewski, Adam J.
Reagan, John L.
author_sort Hsu, Andrew
collection PubMed
description BACKGROUND: SARS-CoV-2 infection has noted derangements in coagulation markers along with significant thrombotic complications. Post-mortem examinations show severe endothelial injury and widespread thrombotic microangiopathy in the pulmonary vasculature. Early reports describing the use of prophylactic anticoagulation demonstrated improved survival, leading to the adoption of prophylactic and therapeutic anticoagulation guided by D-dimer levels. The clinical usefulness of D-dimer values, trends, and more intensive anticoagulation remains an area of clinical interest. OBJECTIVES: Assess the outcomes and laboratory trends in COVID-19 patients stratified by intensity of anticoagulation at time of admission. PATIENTS AND METHODS: Retrospectively review the differences in clinical outcomes and laboratory trends in patients hospitalized with COVID-19 in the Lifespan Health System. RESULTS: Between 27 February and 24 April 2020, 468 patients were hospitalized. Initial use of high-intensity thromboprophylaxis was associated with improved 30-day mortality (adjusted RR 0.26; 95% confidence interval [CI], 0.07–0.97; p = 0.045) without a significant increased rate of bleeding (p = 0.11). In severe COVID-19, D-dimer significantly increased during hospitalization with standard thromboprophylaxis (p < 0.001) but remained stable or decreased with high-intensity prophylaxis or therapeutic anticoagulation. CONCLUSION: Patients who received high-intensity prophylactic anticoagulation had a downtrend in D-dimer levels and improved 30-day mortality. This suggests a role in anticoagulation in mitigating adverse outcomes associated with COVID-19; however, further randomized, prospective studies are needed.
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spelling pubmed-75112072020-09-24 Intensity of anticoagulation and survival in patients hospitalized with COVID-19 pneumonia Hsu, Andrew Liu, Yuchen Zayac, Adam S. Olszewski, Adam J. Reagan, John L. Thromb Res Letter to the Editors-in-Chief BACKGROUND: SARS-CoV-2 infection has noted derangements in coagulation markers along with significant thrombotic complications. Post-mortem examinations show severe endothelial injury and widespread thrombotic microangiopathy in the pulmonary vasculature. Early reports describing the use of prophylactic anticoagulation demonstrated improved survival, leading to the adoption of prophylactic and therapeutic anticoagulation guided by D-dimer levels. The clinical usefulness of D-dimer values, trends, and more intensive anticoagulation remains an area of clinical interest. OBJECTIVES: Assess the outcomes and laboratory trends in COVID-19 patients stratified by intensity of anticoagulation at time of admission. PATIENTS AND METHODS: Retrospectively review the differences in clinical outcomes and laboratory trends in patients hospitalized with COVID-19 in the Lifespan Health System. RESULTS: Between 27 February and 24 April 2020, 468 patients were hospitalized. Initial use of high-intensity thromboprophylaxis was associated with improved 30-day mortality (adjusted RR 0.26; 95% confidence interval [CI], 0.07–0.97; p = 0.045) without a significant increased rate of bleeding (p = 0.11). In severe COVID-19, D-dimer significantly increased during hospitalization with standard thromboprophylaxis (p < 0.001) but remained stable or decreased with high-intensity prophylaxis or therapeutic anticoagulation. CONCLUSION: Patients who received high-intensity prophylactic anticoagulation had a downtrend in D-dimer levels and improved 30-day mortality. This suggests a role in anticoagulation in mitigating adverse outcomes associated with COVID-19; however, further randomized, prospective studies are needed. Elsevier Ltd. 2020-12 2020-09-23 /pmc/articles/PMC7511207/ /pubmed/32980620 http://dx.doi.org/10.1016/j.thromres.2020.09.030 Text en © 2020 Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Letter to the Editors-in-Chief
Hsu, Andrew
Liu, Yuchen
Zayac, Adam S.
Olszewski, Adam J.
Reagan, John L.
Intensity of anticoagulation and survival in patients hospitalized with COVID-19 pneumonia
title Intensity of anticoagulation and survival in patients hospitalized with COVID-19 pneumonia
title_full Intensity of anticoagulation and survival in patients hospitalized with COVID-19 pneumonia
title_fullStr Intensity of anticoagulation and survival in patients hospitalized with COVID-19 pneumonia
title_full_unstemmed Intensity of anticoagulation and survival in patients hospitalized with COVID-19 pneumonia
title_short Intensity of anticoagulation and survival in patients hospitalized with COVID-19 pneumonia
title_sort intensity of anticoagulation and survival in patients hospitalized with covid-19 pneumonia
topic Letter to the Editors-in-Chief
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511207/
https://www.ncbi.nlm.nih.gov/pubmed/32980620
http://dx.doi.org/10.1016/j.thromres.2020.09.030
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